The Influence of Indonesia National Health Insurance Program’s

PROLANIS to Controlling Patient with Diabetes Mellitus Type 2

Anisa Fitri Nur Heriantoro

Faculty of Public Health, Universitas Airlangga, Mulyorejo, Surabaya, Indonesia

9e.30.spentaru@gmail.com

Keywords: Indonesia, National health insurance, Controlling, Patient with Diabetes Mellitus Type 2.

Abstract: Diabetes mellitus type 2 is a chronic disease caused by resistance to insulin that is often associated with an

unhealthy lifestyle. Diabetes mellitus type 2 has serious disease complications if it’s not controlled from the

outset. These complications include coronary heart disease, stroke and others disease. Therefore, it needs

appropriate handling and control for people with type 2 diabetes mellitus in order not to suffer from

complications. In the National Health Insurance in Indonesia called JKN, there is a chronic disease

management program known as PROLANIS, which also manages diabetes mellitus type 2 preventively and

promotively. The purpose of this research is to find whether the PROLANIS program in JKN runs

effectively in controlling patient with type 2 diabetes mellitus to avoid complications. The method used in

this research is literature study by reviewing articles and scientific journals related to the PROLANIS

program. The results obtained in several articles and scientific journals say that with the PROLANIS

program it can control some of the clinical diagnostic tests of patients’ diabetes mellitus type 2 so that no

complications arise and the quality of life increases. But the continuity of some activity isn’t good enough,

as caused by low attendance of participants. The conclusion in this research is that the PROLANIS program

can control patient with diabetes mellitus type 2 to be better and stable so that the risk to experience

complications becomes less, but that there is need of some effort to maintaining membership of PROLANIS

to keep it stable.

1 INTRODUCTION

Diabetes mellitus type 2 is a metabolic disorder

disease caused by the presence of insulin resistance

in the body so that glucose in the blood can’t be

converted into energy and eventually leads to

hyperglycemia conditions or high glucose levels in

the blood. Diabetes mellitus type 2 is one of the

most recognized degenerative diseases worldwide

because of the ever-increasing number of cases over

the decades. According to WHO data, the estimated

population of diabetes mellitus in the world in 2014

is 422 million in the adult group. The number

increased fourfold compared to 1980, which was

about 108 million in the adult group. Increased

incidence of diabetes mellitus is closely related to

the increase in overweight and obesity rates and

other diabetes mellitus risk factors. Global cases of

death from diabetes mellitus and its complications in

2012 reached 3.7 million cases. Of the 3.7 million

deaths, many occurred in low-income countries and

middle-income countries compared with high-

income countries. Complications caused by diabetes

mellitus include heart attack, stroke, and kidney

failure, amputation of the feet, impairment and loss

of vision, and damage to the nerves. Complications

of diabetes mellitus are very serious and require

control efforts so that these complications can be

prevented.

In addition to preventing the occurrence of

complications in patients, such control efforts can

also reduce the burden of the very large medical

costs of these complications. In Indonesia, there is a

health insurance program called Jaminan Kesehatan

Nasional, or more commonly JKN. JKN is a health

insurance program organized by the Badan

Penyelenggaran Jaminan Sosial (BPJS). JKN has a

model such as insurance, whereby participants pay a

premium each month, and, if participants are treated

or visit health facilities, medical expenses will be

paid by BPJS by claim method. With the existence

Heriantoro, A.

The Inﬂuence of Indonesia National Health Insurance Program’s PROLANIS to Controlling Patient with Diabetes Mellitus Type 2.

In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 123-127

ISBN: 978-989-758-335-3

123

of JKN, the people of Indonesia can be guaranteed

in the treatment or visits to the health facility,

because there is no need to reimburse, except for

certain expenses which are not covered by BPJS.

Based on data from BPJS, claims on cases of

diabetes mellitus and its complications in 2015

reached 3.27 trillion rupias. The amount of costs

incurred associated with diabetes mellitus and its

complications require control efforts so that

expenditures do not continue to swell. BPJS, as the

organizer of health insurance, has made efforts to

control the complication of diabetes mellitus disease

by designing a program called PROLANIS.

PROLANIS, or Chronic Disease Management

Program, is an integrated healthcare system by

promotive and preventive efforts in controlling

patient with chronic diseases such as type 2 diabetes

mellitus and hypertension. The aim of the

PROLANIS program is promotive and preventive

and is expected to prevent complications caused by

type 2 diabetes mellitus and hypertension. In

knowing whether the goal of the PROLANIS

program is achieved or not, it is necessary to

monitor and evaluate. To date, there has been no

publication in the electronic media by BPJS related

to the monitoring and evaluation of PROLANIS

programs. Nevertheless, there are several research

journals that examine the effectiveness of

PROLANIS programs in various regions of

Indonesia. From the background, researchers want to

know more about the effectiveness of PROLANIS

program, especially in controlling patient with

diabetes mellitus type 2 and its complications in

Indonesia.

2 METHOD

In this study, the research method used is

descriptive. In the descriptive research method,

researchers describe the effectiveness of the

PROLANIS program in controlling patient with

diabetes mellitus type 2 and its complications. Data

are obtained through literature study by reviewing

the journals and scientific articles that examine the

effectiveness of the PROLANIS program related to

diabetes mellitus type 2 disease. The data obtained

will be reviewed and analysed and concluded to

determine whether the implementation of

PROLANIS program is effective or not.

3 RESULT

In BPJS, there is no publication of monitoring and

evaluation of PROLANIS program, so it is not

known whether the PROLANIS program has been

effective or not. However, there are several scientific

journals that discuss the effectiveness of

PROLANIS programs in several regions of

Indonesia. In the scientific article Analysis of

Implementation of Chronic Disease Management

Program (PROLANIS) on Family Doctor PT ASKES

in Palembang City in 2013 by Asupina, Misnaniarti

and Rahmiwati, it explained that the PROLANIS

program in Palembang City has been well

implemented (Assupina, Misnaniarti and Rahmiwati,

2013). From the various activities that are part of

the PROLANIS program, there are some that have

not run optimally (Assupina, Misnaniarti and

Rahmiwati, 2013). These include 1) HBA1C

examination, 2) home visit, 3) the establishment of

clubs, and 4) sports together (Assupina, Misnaniarti

and Rahmiwati, 2013). The following picture of the

activity checklist table on the PROLANIS program

was conducted by family doctor PT ASKES in

Palembang City.

Table 1: Activities Checklist in Family Doctor PT ASKES

in Palembang City (Assupina, Misnaniarti and Rahmiwati,

2013)

Name of Activity

Informant

Health

Consultation

√

GDP/ GDPP,

BMI, and Blood

Pressure’s Check

√

HBA1C’s Check

√

Rapid Reverral

Drug

Services

√

Monitoring

Health

Status Routinely

√

Home visit

√

Club’s Forming

√

Health Education

√

Doing Exercise

Together

√

Reminder

√

Some activities have not run optimally due to

internal and external factors in the PROLANIS

program, such as in the formation of a club, where,

INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association

124

because of the the constraints of a busy doctor,

participants not willing to be involved, or there is no

location to gather (Assupina, Misnaniarti and

Rahmiwati, 2013).

In terms of membership, the PROLANIS

program, especially for type 2 diabetes mellitus,

increased participants from the original 263 to 285

participants (Assupina, Misnaniarti and Rahmiwati,

2013). Related to monitoring and evaluation, this

has been going well wherein the reporting from

family doctors to PT. ASKES Palembang branch

and regional branch is always on time (Assupina,

Misnaniarti and Rahmiwati, 2013). The provider in

this case is PT. ASKES which also routinely

monitors family doctors (Assupina, Misnaniarti and

Rahmiwati, 2013).

In the research article The Integration of

Preventative Program Disease Diabetes Mellitus

Type 2 PT. Askes (Persero) to the Badan

Penyelenggara Jaminan Nasional Kesehatan (BPJS

Kesehatan), Idris (2014) explained that membership

of the PROLANIS program has increased rapidly,

but the sustainability is very low (Idros, 2014).

Based on membership data in the PROLANIS

program 2010-2013 period, PROLANIS for type 2

diabetes mellitus had 311 participants in January and

1702 participants in December.2 In 2011, there was

an increase of 3122 participants (Idris, 2014). In

2012, there was a rapid increase, in which

participants reached 96,897 participants (Idris,

2014). In 2013, membership increased to 100,302

participants (Idris, 2014). However, the participation

of high PROLANIS programs is not accompanied by

good program sustainability. PROLANIS program

visit rate is very low and always decreases every

year (Idris, 2014). In 2010, from the 311 participants

in January, participants who visited for the

PROLANIS program were just 187 participants or

only 60.13% (Idris, 2014). In 2012, from 96,897

participants, those who visited were only 3,515

participants or just 3.63% (Idris, 2014).

From the other aspect, the level of health of

participants experiences fluctuations (Idris, 2014)

whereby there is an increase in the examination of

the achievement of fasting blood glucose

examination target (in 2010 by 10% to 16.9% in

2012), post-prandial blood glucose (in 2010 by

13.3% to 23.2% in 2012), and body mass index

(2010 to 26.7% to 32% in 2012) (Idris, 2014). On

HbA1C examination, there was a drastic reduction

in the achievement of targets, from 62.1% in 2010 to

1.2% in 2012 (Idris, 2014). Below is a graph of

achievement targets related to the health level

examination of PROLANIS program participants in

2010-2012.

Figure 2: Graph of Achievement of Target Related

Inspection of Health Level Participants PROLANIS

Program Year 2010-2012

(Idris, 2014).

In terms of cost, once tested, the correlation is

found that the more participants visit the

PROLANIS program, the lower the costs to be

incurred in the hospital (Idris, 2014). As for the

effectiveness of PROLANIS program itself, after the

correlation is tested it is seen that the reduction of

costs to be incurred in the hospital due to effective

PROLANIS program occurs after 2-3 years of

implementation of the PROLANIS program

(Idris,

2014).

4 DISCUSSION

PROLANIS is a chronic disease control program

organized by BPJS. The PROLANIS program has

the purpose of encouraging JKN participants who

have chronic diseases, in this case type 2 diabetes

mellitus and hypertension, to have a good quality of

life (BPJS, 2015). The goal is measured by 75% of

participants who visit first level fasces and have

good results in specific examinations according to

clinical guidance of the program PROLANIS (BPJS,

2015). In the PROLANIS program there are several

activities: 1) consultation/ educational activities, 2)

home visit, 3) reminder, 4) club activity, and 5)

health status monitoring (BPJS, 2015). Consultation

activities are conducted on the basis of the

agreement of participants with primary healthcare

(BPJS, 2015). In this case, it is expected that a

minimum of primary healthcare is the forming of

one club/ group for education to be implemented

(BPJS, 2015). The reminder activity is an activity to

remind the related participants of the consultation

schedule to the first level fasces that he chooses

(BPJS, 2015). The home visit activity is a visit to the

participant's home to provide self-health and

environment-related education to the participants

The Inﬂuence of Indonesia National Health Insurance Program’s PROLANIS to Controlling Patient with Diabetes Mellitus Type 2

125

and their families (BPJS, 2015). Home visit

activities are conducted when new participants are

registered, absent for three consecutive times,

physical examination is not good, and post-

hospitalization (BPJS, 2015).

From the BPJS, especially the primary service

management department, there has been no

publication on the Internet related to the monitoring

and evaluation of the PROLANIS program, so not

everyone knows the effectiveness of the PROLANIS

program. However, in the several scientific journals

discussing the effectiveness of the PROLANIS

program, it is considered that the PROLANIS

program has not been run properly. This is evident

in the lack of some activities, such as the formation

of clubs for education and other group activities

(Assupina, Misnaniarti and Rahmiwati, 2013). In

addition, the rapidly increasing membership of

PROLANIS programs is not followed by the

continuity of participants in following the activities

of the PROLANIS program

(Idris, 2014).

According to research by Swastini, D.A, Putri

S.A, Rudiarta N.M, Wiryanthini I.A.D (2016),

patient with hypertension which using JKN, diastolic

blood pressure decreased significantly. The patient

do outpatient treatment in hospital around six month

with the help of JKN. Another literature study by

Della P.S, Mirtha T.L (2016), noted there’s

connection between the successes of blood pressure

control with health insurance participation. Patient

who don’t have health insurance increase the risk of

uncontrolled blood pressure. With health insurance

which one of them are JKN, patient can get

treatment to control their blood pressure and prevent

complication without worried about high cost.

Of the various problems, the BPJS, especially

the primary service management department, should

make efforts of continuity so that participants who

have signed up always follow the activities on the

PROLANIS program. Such endeavours are not

necessarily by devising new endeavours, but can

also utilize old efforts through reminders. In addition

to SMS, reminders may also be done through social

media on the Internet owned by participants. In this

modern era, people have started to become Internet

literate and utilize it effectively. Social media on the

Internet that may be used include the LINE

application, WhatsApp, etc. Another possible effort

is to add facilities and facilities for optimizing

activities. As with educational activities, it is

possible for participants to be given a snack so that

participants are happy and interested to participate,

or to also provide games or role-play so that

participants do not get bored with the education

provided. Maintaining the continuity of participants

in following the various activities in PROLANIS

program, especially related to controlling patient

with type 2 diabetes mellitus, will impact on

improving the quality of the program.

5 CONCLUSIONS

PROLANIS is an effort undertaken by BPJS to

control chronic diseases, which, in this case, is type

2 diabetes mellitus. There is no publication by BPJS

on the Internet related to the monitoring and

evaluation of the PROLANIS program. However,

there are several scientific journals that have

examined the effectiveness of PROLANIS

programs. From these journals, it was found out that

the PROLANIS program is able to improve health

examination to be better, but it is not balanced with

the continuity of activities and low participated on

the PROLANIS program. It is necessary to keep

participants in the activities of PROLANIS

programs, such as by reminding through social

media on the Internet or add some facilities such as

snacks or games and doing role-play so that

participants are interested to continue to follow the

activities in PROLANIS program, especially related

to diabetes mellitus type 2.

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